Healthcare Provider Details

I. General information

NPI: 1518947043
Provider Name (Legal Business Name): DONALD LEE KLINE CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18504 NELSON RD
COVINGTON LA
70435-8034
US

IV. Provider business mailing address

18504 NELSON RD
COVINGTON LA
70435-8034
US

V. Phone/Fax

Practice location:
  • Phone: 985-285-9035
  • Fax: 985-276-4813
Mailing address:
  • Phone: 985-285-9035
  • Fax: 985-276-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: